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A <br />Complaint Investigation Form <br />COMPLAINT ID: C00046516 Site Location: 5308 PACIFIC AVE <br />Received by: EE0000040 JIMENEZ <br />Assigned To: EE0000753 NG <br />Program/Element Code:1600 - FOOD PROGRAM <br />Complainant: : <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Report #: 5104 <br />Account ID: : <br />Print Date: 4/30/2018 4:52: I I PM <br />ure of complaint: <br />THIS COMPLAINT WAS FOUND IN FILING CABINET AND ALLEGES "ON 12/18/1991 ATE TERIYAKI CHICKEN AND FRIED RICE AT 2:45 PM AND <br />AT 8:30 PM. BECAME ILL WITH VOMITING -CHINESE RESTAURANT ACROSS FROM MCDONALD'S -NAME IS NOT KNOWN." ORIGINAL CO <br />#912238 DATED 12/19/1991 (GIVING ITAN ENVISION COMPLAINT # TO HAVE IN DATABASE FOR FUTURE REFERENCE.) <br />Complaint Mode: P Complaint Mode Codes A -Agency Referral B-Bd of Supervisors / City Council C -Counter F -Fax <br />E -Code Enforcement M -Mail / Correspondence O -Other EH Unit P -Phone <br />I -Internet / Email S -Sheriffs Office <br />PROPERTY INFORMATION <br />Property Name: <br />Site Location 5308 E PACIFIC <br />STOCKTON, CA 95207 <br />Cross Street <br />Phone <br />District 002 - MILLER, KATHERINE <br />APN 10224021 <br />PROPERTY OWNER INFORMATION <br />Responsible Party or Property Owner: CHINESE RESTAURANT SIIERWOOD MF <br />RP/DBA CHINESE RESTAURANT SHERWOOD MALL <br />RPAddress 5308 PACIFICAVE <br />STOCKTON, CA 95207 <br />Billing Address 5308 PACIFICAVE <br />Home Phone <br />Work Phone <br />Location Code 0I -STOCKTON <br />Date Abated - <br />Inspector ID #: C j <br />------------------------------------------------------------------ <br />-----------------------------�------------------------------------------------------------------------------- <br />Send Referral to Referral Letter Sent by <br />Referral Address Date: <br />Complaint Status Code: l <br />Circle appropriate Status Code <br />01 - Field Response -Violations Cited and Corrected <br />02 - Office Response Only <br />06 - Violations Cited - see Linked PROGRAM FACILITY FILE <br />07 - Refferred to Other Agency <br />08 - Unable to Verify Alleged Complaint <br />10 - POSTED SUBSTANDARD/UNSECURED - See Housing File <br />11 - Multiple Complaints - SEE ACTIVE CASE # <br />12 - DA Referred Complaint -See Program Enforcement Action Form <br />15 - ACTIVE HOUSING CASE - NEW COMPLAINT see ACTIVE CASE # <br />28 - Alleged FBI - No Major Violations Identified <br />29 -Alleged FBI - Major Violations Identified <br />50 - LEAD Assessment Performed -No Abatement Required <br />52 - LEAD Abatement Reqired-See Program Record File <br />97 -,Disaster Planning and Response <br />99 'UNSPECIFIED -Old Complaint -No Original Found <br />MN - EHD Monitoring Status <br />PD - Permit Issued -Pending Well Installation <br />RS - Resolved - New Well Installed <br />S1 -Tank pumped <br />S2 - Hooked up to public sewer <br />S3 - Septic system repaired <br />omp aint Reviewed by:ate Updated y: _ Dat ,1-1 <br />1 �x � ;��� L - �; f. <br />5104. rpt <br />